Association between Kidney Donor Profile Index (KDPI) and Kidney Transplant Outcomes in Non-US Cohorts:A Systematic Review

Introduction. End-stage kidney disease is a global health issue. While prediction models like the Kidney Donor Profile Index (KDPI) assess donor quality, the published evidence on its performance is heterogenous. This study aimed to systematically review the association between KDPI and transplant outcomes to optimize clinical decisions and allocation strategies.Methods. We searched PubMed, Scopus, and Web of Science for studies up to December 2024. We included studies on adult kidney transplant recipients that reported KDPI values and compared them with transplant outcomes. The review question was structured according to PICO: population, adult kidney transplant recipients; exposure, KDPI; comparator, lower KDPI categories or lower donor-risk strata; and outcomes, graft survival, patient survival, delayed graft function (DGF), and kidney function. Studies were assessed for quality using the Newcastle-Ottawa Scale. Exclusion criteria involved non-human, pediatric studies, and research without specific transplant outcomes. A grey literature search via Google Scholar, as well as backward and forward citation searching were performed.Results. Overall, 10 studies met the inclusion criteria. These studies included 15,879 participants and were conducted across several countries, mostly in Germany. Higher KDPI values were associated with poorer graft survival, reduced kidney function, and an increased incidence of DGF. However, the relationship between KDPI and patient survival was less clear, with some studies reporting no significant association.Conclusions. Higher KDPI values were associated with poorer graft survival, increased risk of DGF, and reduced kidney function post-transplant. Further studies should explore its interaction with recipient factors and long-term outcomes.